Fixation Sequence in a Patient with Multiple Mandibular and Midface Fractures: A Case Report

Herein, we describe the management of multiple mandibular and midface fractures using the “bottom-up,” “tooth-bearing–non-tooth-bearing,” and “outside–inside” fixation sequence in an 18-year-old female. The patient presented with a Le Fort I fracture along with fractures in the left mandibular body, left condyle, right mandibular angle (comminuted fracture), inferior orbital rim (bilateral), and left zygomaticomaxillary complex. Open reduction internal fixation and wire intermaxillary fixation were performed. Miniplates were placed in the inferior border of the mandible and superior to the mental foramen in the left mandibular body using an intraoral approach. The right mandibular angle fracture was fixed using a reconstruction plate in the inferior border of the mandible and a miniplate 2.0 to maintain the position of the comminuted bone fragments. Miniplates were placed on the anterior and posterior parts of the left condyle using a preauricular approach. For the midface fractures, plates 1.5 were placed on the frontozygomatic fracture line and the left inferior orbital rim using a subciliary approach with a lateral extension. “L” plates were fixed on the zygomaticomaxillary and nasomaxillary buttresses.